Pediatrician Finances: The New Attending Guide

Pediatrics hands you one dominant first job: the employed position at a nonprofit children's hospital or academic center. The pay arrives on an academic band, the job is described in FTE fractions, and the employer almost always qualifies for Public Service Loan Forgiveness. That combination means the first year decisions here are employer shaped in a way they are not in most specialties. The loan plan is usually decided by the employer's tax status. The retirement menu is usually a 403(b) with a 457(b) beside it. The contract argument is usually about how much of your week is clinical.

The numbers:

Employer mix: children's hospitals and academic centers dominate pediatric hiring, which is why the forgiveness count and the two deferral menu show up so often in this specialty, and why so many pediatricians hold a qualifying employer without planning to. Private groups add the ownership track and take forgiveness off the table. Which employer you pick sets your loan options, your retirement menu, and your coverage gaps in one move, which is why this page treats the first job as the decision everything else hangs from.

Read a children's hospital offer as an FTE split. The salary line assumes a job description: a clinical fraction that sees patients, plus teaching, research, quality, or administrative fractions that do not produce visits. If the clinical fraction grows after you sign, and it usually tries to, the same salary buys more work and the pay per clinical hour falls without anyone cutting your pay. Then the rest of the real terms surface: how call is counted and what the stipend pays, whether any production or incentive component exists above the band (the Medscape average incentive bonus for pediatricians is $26,000, the second lowest in the report, so do not budget a large one), and how the band itself is set and reviewed. The full treatment is on the contracts and income page.

Worked math: What should a pediatrician check in a first contract at a children's hospital?; How much do pediatricians make?.

Pediatrics is where the loan decision and the employer decision are the same decision. Take the nonprofit children's hospital job and the forgiveness track usually wins by a wide margin: training months already banked, income driven minimums at attending pay, and the remaining balance cancelled tax free at payment 120. Take the private practice job and the same balance has to be repaid in full, and payoff speed or a refinance becomes the plan. While any forgiveness chance exists, loans sit at waterfall step five: minimums on an income driven plan, employment certified every year, never a dollar extra. The default plan, the exceptions, and the employer help fine print are on the student loans page.

Worked math: Is PSLF at a nonprofit children's hospital my best loan strategy?; How long will it take to pay off $200,000 in student loans as a pediatrician?; Can my employer repay my student loans tax free under Section 127?.

Your biggest asset is still your ability to earn, and the protection order does not change at the lowest salary in medicine: disability above all, term life if anyone depends on the income, umbrella behind both. What changes is the discipline. At a pediatrician's pay, every premium dollar competes with the savings rate, so each layer gets sized to the income it protects and no layer gets sold past its job. The academic trap is assuming the benefits packet is the plan: group disability at a children's hospital is capped, built on the plan's definition, and ends when the job does, and the guaranteed issue offers that were open in residency close at graduation. The full treatment is on the insurance page.

Worked math: Does a pediatrician need own occupation disability insurance?; How much term life insurance does a pediatrician need?.

The account menu follows the employer, and academic employment deals pediatricians the strongest hand in this hub. A nonprofit system hands you a 403(b). Government employers add a governmental 457(b); many nonprofit systems offer a non governmental 457(b) with the same separate limit, but the money stays exposed to the employer's creditors. The 457(b) carries its own separate $24,500 deferral limit for 2026, which means two full deferrals before anything else opens. Inside the waterfall the order is fixed: the match first, then coverage and the reserve steps, then the backdoor Roth, then the max tier in its own order, the HSA first at $4,400 for self only coverage or $8,750 for family coverage in 2026, then the workplace plan to the $24,500 deferral limit, then the governmental 457(b) where you have one, then mega backdoor space last. Then the reserve finish, then taxable. The two deferral menu and the part time reality of this workforce are on the retirement page.

Worked math: What order should a pediatrician fund retirement accounts in?; Can I stack a 403(b) and a 457(b) at a children's hospital?; Pediatrics pays among the least in medicine. How do I still retire on time?.

Ownership in pediatrics is an honest fork. The hospital employed job needs no buy in, keeps the forgiveness count alive, and caps your upside at the band. The private practice buy in opens an equity door at the specialty where reimbursement pressure is the most documented in medicine, which means the books, the payer mix, and the partner income spread decide whether the door is worth walking through. The ownership page prices the buy in and names what employed pediatricians build instead of equity.

Housing runs on the same discipline as every other specialty here: rent through the first year in a new market, buy after the reserve is finished and the job has proven itself, and let the payment, not the approval, size the house. A physician mortgage avoids PMI with a low down payment; it does not make a first year house on a new contract a safe move.

Worked math: Should I join the private pediatrics practice offering partnership or take the hospital employed job?; Is buying into a pediatrics practice still worth it with reimbursement falling?; How much house can a pediatrician afford?.

The estate layer at this stage is plain, and it is the layer this specialty's cases most often find unfinished. Guardians come first: if both parents die while the children are minors, a court chooses who raises them unless a signed will names a guardian. The floor after that is three documents per adult, a will, a financial power of attorney, and a health care directive. Documents govern only what titling and beneficiary forms let them govern, so the signing and the beneficiary pass belong on the same afternoon. The full treatment is on the estate planning page.

Worked math: What estate documents does a new attending pediatrician need first?.

Read the full case: Sarah and Michael, scored 59 out of 100, with five fixes to a 75.

Ryan Inman is a retired financial planner who worked with about 500 physician families. He created the Financial Residency podcast (about 3 million downloads) and is no longer affiliated with it. Financial Fellowship is his sole focus. This guide is educational. Last updated October 2026.